Breast Augmentation FAQs

Speaker 1 (00:03):
Welcome to Kind of Beautiful with board certified plastic surgeon Dr. Tracy Pfeifer, the podcast for women seeking the very best of modern beauty.

Dr. Pfeifer (00:16):
The first question when considering breast augmentation surgery that patients ask about is, you know, what size am I gonna be or what size can I be? Or I wanna look natural, can I look natural? Before patients come in for a consultation, a lot of times they're home and they're trying to figure out, you know, what, implant's gonna be the right one for them. They're looking at a lot of different websites with volumes and shapes and they're trying to figure out, oh, or their friend had surgery and she has 400 ccs, so they want 400 ccs. But the best way to try to get a handle on this on your own before you come in for your consultation is to look at different websites with their before and after galleries and try to find somebody that's similar to you in terms of their frame, the shape of the breast, how much volume the breast has, and then look at the post-op result.

(01:15)
And if you like that post-op result, get that implant information. It'll give you an idea, give you a ballpark idea of what size and type of implant might look best on you. But it always requires an in-person visit because particularly for breast augmentation measurements are very, very important. It's a very important factor in determining which implant's gonna look the best on you. The before and after photos are the biggest uh, selection is on uh, dr pfeiffer.com. Just go to the gallery section and you will see the different categories for uh, breast implants and you can click on some of those patients. And we also post, uh, select patients on Instagram. But the biggest library of before and after pictures is on the website@drpfeiffer.com and just select the gallery in the menu bar. When the patient comes in for breast augmentation, we need to take measurements of the breast.

(02:12)
The breast has a width, it has a height, and then it also has different distances. So for example, the distance from the nipple down to the crease of the breast, which we call the inframammary fold. That's an important measurement. Another important factor is how much breast tissue the patient has, whether or not she has any sagging of the breast. So particularly with respect to width, we wanna have the right width implant because if it's too narrow, it's not gonna give us the fullness on the outer breast that we want. So we look at a person standing straight on, we wanna see a little curvature of the outside of the breast. We don't wanna see the ribs and the chest wall first. We see a little curve of the breast and then that goes into the waist and then balances the hips. So if the implant base or the width of the implant is too narrow, you could still have a full breast because it could come out further from the chest wall.

(03:15)
But if you don't have that curve on the side, the breast will look full, but you won't look balanced between the breast and the hips. So we wanna have an implant that's, I call it the Goldilocks, with you want it to be just right. You don't want it to be too narrow and you don't want it to be too wide because if it's too wide then it could start to fall kind of in almost into your armpit. Or it could also just look at it proportionate with your hips. So we wanna have the correct width. And then if we're using a round base implant, that means that the width of the implant is the same as the height of the implant because it's round. Now if your natural breast has a round footprint, meaning the width and the height are very close, then a round base implant will look very good on you.

(04:07)
And in the United States, probably the majority of patients have a round base implant, but sometimes a patient may have an oval footprint where the width of the breast is wider than the height. So the width is let's say 13 centimeters. And the height is for the sake of discussion, 10.5 centimeters. If you put in around implant with the correct width of 12 centimeters, the height's gonna be 12 and that height is gonna be too tall for your natural breast. So we have to consider if we're gonna be happy with how that will look because it might give you excessive fullness in the upper half of the breast. It can distort some of the natural landmarks of the breast, especially where the pectoralis major muscle comes in and intersects the chest wall. There's that little indentation. We should try to maintain that because that's what makes the breast look natural.

(05:04)
If the implant is too tall, the distance from the clavicle to the top of the breast will be short. And also that can throw off how the breast looks. It won't look natural because most of the implant volume will be above the level of the nipple. You want the volume of the implant to be about 50% above the nipple and 50% below. So the measurements are very important and that's something that really has to be done in the office and sort of sets the stage for which types of implants we're gonna be considering for that particular patient. Breast augmentation surgery when it's done for the first time, in other words, it's not a revision usually takes between two and two and a half hours. In my practice I use sizers a lot. So if a patient has asymmetry or we're not sure you know exactly which implant's gonna be the absolute perfect for the patient, I'll make the pocket put in a sizer, which is an implant that's not meant to be a permanent implant in place forever.

(06:07)
And then while the patient is sleeping, we have the sizer in place. I'll ask the anesthesiologist to put the back of the bed up and I will look from the foot of the bed with the patient in the upright position to see how that device looks and if they have asymmetry, trying different combinations, slightly larger on one side, slightly smaller on the other side to see which will give us the highest degree of symmetry. And once that's done, the patient has the sizes removed and then I do all the pocket irrigations and put in the, the permanent implants. So some of it depends on how much asymmetry they have, if they have any, which most people do <laugh> and that's how we do it. Now there are other plastic surgeons who will never use sizes. They just go into the operating room and they say, this is it.

(06:50)
These are the implants that we're going to use. And that's one way to approach it. But I prefer to do it with sizers if, if it's needed. A lot of times the first set of sizers that I put in is, is what we're gonna end up using. So I would say about two hours is typical, but with asymmetry it can take a little bit longer, about two and a half hours. In terms of the age for surgery, anybody who's 18 or older can have breast augmentation surgery. There are certain situations where patients may have some congenital asymmetries where we'll do implants, you know, younger than 18, that happens with people with um, severe tube burst breast or other chest wall deformities with sort of a concavity of the chest wall, which we call pectus. Now if a patient is 18, between 18 and 22, silicone implants are FDA approved for people who are 22 years and older.

(07:46)
So I still will use silicone implants in a patient under 22. But we're using it in an off-label situation where the patient signs a special consent understanding that it was not technically approved for her age group. There's no reason for this. It's just the patients that they studied initially during the approval process, they probably didn't have a lot of patients that were in the 18 to 20 year old age group. So we can still use silicone implants, but we get an off-label consent. So depending on what's going on with them physically, if they have a congenital abnormality and if they do have a congenital abnormality that requires an implant and the patient is emotionally mature enough to accept having the surgery along with of course her parents' consent, there are a few situations where we'll do it less, uh, younger than 18, but other than that, 18 or older is fine.

(08:36)
And when we're talking to our younger patients who haven't had children yet, we have to make sure that we understand that after the pregnancy, the breasts usually have gotten larger during pregnancy, they may or not have breastfed, the breast tissue's going to shrink a little bit after the milk recedes and they may have lost fullness in the upper half of the breast. So we may need to do a revision to regain that upper pole fullness that was lost or the skin might have stretched. So we might need to do a lift and maybe we need to change the implant as well after pregnancy. So it's important for the younger patients to understand that the aesthetic result may be affected by a future pregnancy and may require an additional surgery to get the cosmetic result that they're looking for. The only thing I would say in terms of people who are not candidates for breast augmentation, I would say that the definite category is somebody who has a personal history of an autoimmune disease or many family members who have an autoimmune disease.

(09:44)
I did have one patient who I discussed in a previous podcast that had a history of autoimmune disease that had been quiet, it hadn't flared up for many, many years. It had flared up during her pregnancy and then resolved she had a breast implant put in and she did not tolerate it. So I think anybody who has a really strong family history or certainly a strong personal history of an inflammatory or autoimmune rather type of disease, we would have to think long and hard about whether or not she should put in an implant. We have done it in people who have like fibromyalgia and things like that and they've been okay. But I do think that's a discussion point with the patient in terms of risk and benefits that it's possible that a foreign material would cause a flare of their autoimmune problem. So really on a case by case basis, we have to talk to the patient about that.

(10:41)
Obviously anybody who has some type of underlying medical problem, you know, cause this is elective surgery, so if you have, you know, heart disease or an active process going on that's not well controlled, you know, high blood pressure, something like that, you're not gonna have elective breast surgery or any elective surgery for that matter. Patients can optimize their results by doing a few things before surgery. The first is to avoid sugar because sugar is very pro-inflammatory and we wanna have a certain degree of inflammation, but we don't want a lot of inflammation. So a low sugar diet starting about two weeks before surgery is always very helpful. The other thing that we ask people to do is take supplemental vitamin C because vitamin C helps in the collagen formation process and scar tissue, which is what needs to happen for us to heal it's collagen.

(11:34)
So we basically are taking vitamin C to help our collagen synthesis and if the patient has uh, more pigmented skin, they might be more prone to have hyperpigmentation around the incision. So we start those patients on a hydroquinone cream which suppresses the activity of the melanocytes. So after surgery, when the fibroblasts are making a lot of collagen, the melanocytes are also stimulated to work and their output is melanin and we don't want to get excess melanin around the scar. So we have them use the cream twice a day starting about 10 days before surgery and then we restart it after surgery as well. And some patients will also take arnica and brolin, which is fine, that can help reduce swelling and bruising a little bit. So some patients will start that preoperatively. I would think the main thing that we advise people to do is to avoid the sugar and avoid anything that can cause bruising.

(12:35)
So those include red wine vitamin E in larger doses, not something in a multivitamin, but like a single vitamin E, whatever, a thousand units, 2000 units don whatever it is, a hundred units don't take any just vitamin E only supplements. We advise patients to stop all herbal supplements because a lot of them, we don't know if they thin the blood or not. I had a patient once, she was taking like 12 different supplements and she stopped them four weeks before surgery and she still developed some bleeding with a little hematoma around her surgical site in her tummy tuck. She was just taking too many supplements that were thinning the blood. So avoid all of those blood thinners. Avoid Aleve, naprosyn, the only thing you should really take if you have a headache or some joint pain is Tylenol because Tylenol doesn't thin the blood.

(13:31)
Anything that thins the blood could lead to bruising and we just, we don't want it because it's not good for us to have that. We don't want to have any blood around the implant. We want it to be a spotless pocket with no blood because blood can be associated with capsular contracture too. So avoid all blood thinners and we give everybody a really extensive list of medications and we always tell them if you have any question about whether or not you can take something, just call us. In our practice. The um, price ranges from approximately 10 to $14,000. It depends on uh, the type of implant we're using, whether or not the patient has asymmetry, which would take a little bit longer to correct. So that's a general price range. 10 to $14,000 patients have a lot of options when it comes to paying for surgery.

(14:19)
We have patient credit programs that are operated through one company called CareCredit, which a lot of people are familiar with. There's a second company that offers financing called Alpheon and I'll talk about those in a second. So patients can pay by check cash credit card, some people will sort of prepay on a plan, which is fine. You can use a combination of payment methods, you could use a credit card, you could use CareCredit. The patient financing programs are interesting because the patient basically gets a loan from the company and then if you pay it off within the designated period of time, which is usually 12 months, there is no no penalty to the patient. So you're basically getting a loan of the money and there's no interest payment by the patient. But you have to have your eyes open when you use these financing options because if you did not pay off the amount on 12 months in one day, they are going to charge like a 24% interest rate retroactive to the first day of the loan.

(15:28)
So it's very easy to go online either CareCredit or Alpheon and just plug yourself in with no commitment and we can help walk you through this process also. And you could see for a certain amount of money that you take out, you know, what your monthly payment would be and then you can see if it, it works with your monthly budget to make that repayment on time. And Kelly in our Quogue office is really great at helping patients, you know, go through CareCredit or Alpheon and figuring out if that's an option that's best for them. You know, we're lucky cuz we get patients from all over the country and we just love that and we're really good at helping them coordinate their surgery with us. So it does take a little bit of work. <laugh>, we do as much as we can via Zoom and then we do have to have the in-person visit for measuring and trying on sizes in the office, which is a really important part of our process.

(16:19)
We always like to use our little sizer bra and put the implants in, stand in front of the full length mirror and see yes no, and figure out what we wanna do with our implants. So depending on where they're coming from, like right now we're working on a patient who's gonna be coming from Alaska. It's a very long trip. She has to take three different flights <laugh>, but we're gonna, we're gonna make it happen for her. So Arlene is really our go-to person for that because she knows what day they need to come in, whether they can come a few days ahead of time that we can do the pre-op visit with the try-on. That still gives us enough time to order the implants. We will help coordinate local arrangements. Some people have family or friends are gonna stay with, some people need local hotel accommodations or Airbnb, which we help them with.

(17:08)
Let's say they're coming by themselves, they might need a patient escort or a nurse to stay with them overnight. We arrange all of that for them. If it's a long flight and it usually is a long flight, we always have the patient come in enough time that we can get an ultrasound of their legs to make sure they don't have any blood clots in their legs resulting from the flight. Because when you have general anesthesia, you're at a slightly higher risk of having a blood clot developed. So we like to make sure the leg veins are nice and clean. We don't have any clots there. We can do all the pre-op with their home doctor. So we send them all the labs they need to get if they need an E K G, if they need a mammogram. All of that is coordinated through our office with Maureen.

(17:56)
And she's really, really good at just walking you through the whole step and steps and just telling you, okay, now we need to do this, we need to do this. And it works well. We have people, like I said, that come from all over the place. Puerto Rico, I mean everywhere. So we're just, we're fortunate that we have a good reputation and people come to us, but I think it's reinforced by the fact that the office makes it really easy for for people to do that. If you'd like to schedule a consultation with the office, you can reach out to us directly by telephone, uh, which is on the website, dr pfeiffer.com. Or you can reach us through the contact, uh, page that's on the website and Arlene will get back to you within 24 hours of you reaching out to us and we certainly look forward to hearing from people. If you have any questions or wanna find out more about your options.

Speaker 1 (18:48):
To learn more, go to Kind of Beautiful podcast.com or follow Dr. Pfeifer on Instagram at Dr. Tracy Pfeifer, spelled P F E I F E R. Links to learn more about Dr. Pfeifer and anything else mentioned on today's show are available in the show notes. The Kind of Beautiful podcast is a production of The Axis, t h e a x i s.io.